Jan 27 Physician Participation in Executions

The death penalty has been a topic of ethical discussion for a long time in the United States. Most people argue over the ethics of the penalty itself, whether or not it should be legal. Others argue over the method of execution, whether death by electrocution or lethal injection constitutes a cruel and unusual punishment. However, one area of discussion that does not get as much attention from the public is the role of physicians and other medical personnel in an execution. That role has increased since the introduction of lethal injection as the preferred execution method.1 If the death penalty will be carried out regardless, does a physician have an ethical duty to make the process as smooth and painless as possible for the convicted? I agree with the American Medical Association and many other medical societies which argue that physician participation in executions is itself unethical.2 Consequently, I think states should either train non-medical technicians specifically for the field of administering lethal injections or look for an alternative method for the death penalty.

The death penalty is legal in thirty-eight states, and lethal injection is currently the preferred method of execution across the board. Seventeen of those states require physician involvement in the procedure, and eighteen others allow physicians to be involved.3 Physician participation is important to note because the process of lethal injection requires an advanced knowledge of certain drugs and medical techniques. In order to administer a lethal injection, the heart rate is monitored and an intravenous catheter is inserted. Most states follow some version of a three step injection process. First, an anesthetic is injected which induces a deep unconscious state. Then, a neuromuscular blocker is injected to paralyze the diaphragm and prevent respiration. Finally, a fatal dose of potassium chloride is injected to stop the heart. After the first injection the whole process takes about eight minutes until death.4 This procedure clearly requires medical expertise including the ability to place an IV, successfully mix and administer a bolus of drugs, and monitor a patient’s state of unconsciousness.

Even though the lethal injection process requires knowledge of medical techniques and many states require the presence of a physician, the involvement of physicians in these executions is limited. Since the American Medical Association and most other medical societies and licensing boards prohibit participation in executions in their codes of ethics, it is often hard for a state to find a doctor to actually perform the execution. Usually a doctor’s role in an execution is limited to watching without providing verbal or physical assistance and certifying the death of the executed person at the end.5 Due to this limited role of physicians, the prison staff typically carries out the execution. Prison staff members are not specifically trained for this procedure and often have trouble successfully placing an IV. Misplaced IVs have led to botched executions in which the recipient either is still alive at the end or clearly endured pain throughout the process.6

The goal of lethal injection was to provide a more humane way to execute criminals. Clearly, in order to avoid unreasonable risk of pain and suffering, someone with medical training must be present and actively participate in the execution. However, since most lethal injections are not carried out by physicians or similarly trained people, the ethics of lethal injection are questionable in their current state. If the government wants lethal injection to be an ethically sound and humane alternative to other execution methods, then it would have to choose to either increase the role of physicians or provide a comparably trained substitute. Given that the medical profession revolves around doing no harm, according to longstanding traditions such as the Hippocratic Oath, the latter is the better alternative.

Most would agree that it would be unethical for the government to warp the traditions and ethical mores of a civilian profession in order to carry out a controversial process of justice. People who argue for increased physician participation in executions say that the role of a physician in an execution is to ensure a quick and painless death for the convicted, which could fall under the normal duties of a doctor to provide comfort and care to a dying patient. However, this situation clearly differs from other end of life situations that a physician might handle. For instance, in an execution they do not interact with the convicted person on the level of a doctor-patient relationship. Instead, their help is enlisted by someone else in order to perform a procedure on an unwilling person. Furthermore, the perceived benefits in this scenario are perverted by the situation since the convicted person is not already dying but rather being forced to die. The intentions of this procedure as a whole are not for the benefit of the criminal but rather for the benefit of society. Thus, enlisting the help of physicians (or any other medical professional for that matter) warps the beneficent intentions of the medical profession.

The government should attempt to adequately train people for lethal injection procedures if it wants to continue to perform that type of execution. However, if it cannot successfully do so without the help of medical schools, physicians, or nurses then it should come up with an alternative execution method. The medical profession should not be assigned the burden of assisting in executions when it goes against its oldest traditions of care and beneficence. The government should administer justice in an ethical way by its own devices.

References:

Lee Black and Robert M. Sade, “Lethal Injection and Physicians: State Law Vs. Medical Ethics,” Journal of the American Medical Association 298 (2007). Accessed January 13, 2017. http://www.deathpenaltyinfo.org/node/2264

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